Tetiana Zhmud1,2, Galyna Drozhzhyna3, Nataliia Malachkova4. 1. National Pirogov Memorial University, Vinnytsya, Ukraine. gtatyana@email.ua. 2. Department of Ophthalmology, National Pirogov Memorial University, Vinnytsya, Ukraine. gtatyana@email.ua. 3. The Filatov Institute of Eye Diseases and tissue therapy of the National Academy of Medical Sciences of Ukraine, Odessa, Ukraine. 4. National Pirogov Memorial University, Vinnytsya, Ukraine.
Abstract
PURPOSE: To evaluate anterior ocular surface damage in patients with type 2 diabetes mellitus and dry eye disease in comparison to non-diabetic controls based on conjunctival impression cytology, objective scales (Efron, Oxford) and OSDI, to correlate vision-related quality of life with grades of squamous metaplasia in T2DM patients suffering from DED. METHODS: All participants underwent complete ophthalmologic examination including Shirmer test, TBUT, conjunctival/corneal staining (Oxford scheme), evaluation of conjunctival redness (Efron grading scale), and conjunctival impression cytology (Nelson's scale). The OSDI questionnaire was completed by both groups of patients to assess severity of DED and QoL. RESULTS: Squamous metaplasia was observed in 94% of the study group and 19.3% of controls (p = 0.0000). Based on the OSDI scores, 73.5% of patients reported mild DED and 26.5% suffered from moderate DED in the study group. The mean OSDI score for the study group with Nelson's grade 2 was 18 ± 3.52 and 20.8 ± 4.68 for Nelson's grade 3, respectively (p = 0.0745). Hence, no significant difference in QoL between grade 2 and grade 3 of squamous metaplasia was observed in patients of the study group. CONCLUSION: Impression cytology is a reliable minimally invasive tool for an accurate evaluation of the ocular surface damage in patients with DED and type 2 diabetes mellitus. Severe squamous metaplasia (Nelson's grade 3) was observed in 29.4% (10/34) of T2DM patients. In contrast, it was not detected in the control group (p = 0.0032). The absence of goblet cells in T2DM patients nether significantly reduces QoL nor contributes to the subjective DED severity (OSDI) due to complex pathways leading to DED. Thus, diagnosis of DED severity should not be solely based on subjective symptoms in this population.
PURPOSE: To evaluate anterior ocular surface damage in patients with type 2 diabetes mellitus and dry eye disease in comparison to non-diabetic controls based on conjunctival impression cytology, objective scales (Efron, Oxford) and OSDI, to correlate vision-related quality of life with grades of squamous metaplasia in T2DM patients suffering from DED. METHODS: All participants underwent complete ophthalmologic examination including Shirmer test, TBUT, conjunctival/corneal staining (Oxford scheme), evaluation of conjunctival redness (Efron grading scale), and conjunctival impression cytology (Nelson's scale). The OSDI questionnaire was completed by both groups of patients to assess severity of DED and QoL. RESULTS: Squamous metaplasia was observed in 94% of the study group and 19.3% of controls (p = 0.0000). Based on the OSDI scores, 73.5% of patients reported mild DED and 26.5% suffered from moderate DED in the study group. The mean OSDI score for the study group with Nelson's grade 2 was 18 ± 3.52 and 20.8 ± 4.68 for Nelson's grade 3, respectively (p = 0.0745). Hence, no significant difference in QoL between grade 2 and grade 3 of squamous metaplasia was observed in patients of the study group. CONCLUSION: Impression cytology is a reliable minimally invasive tool for an accurate evaluation of the ocular surface damage in patients with DED and type 2 diabetes mellitus. Severe squamous metaplasia (Nelson's grade 3) was observed in 29.4% (10/34) of T2DM patients. In contrast, it was not detected in the control group (p = 0.0032). The absence of goblet cells in T2DM patients nether significantly reduces QoL nor contributes to the subjective DED severity (OSDI) due to complex pathways leading to DED. Thus, diagnosis of DED severity should not be solely based on subjective symptoms in this population.
Authors: Margarita Calonge; Yolanda Diebold; Victoria Sáez; Amalia Enríquez de Salamanca; Carmen García-Vázquez; Rosa M Corrales; José M Herreras Journal: Exp Eye Res Date: 2004-03 Impact factor: 3.467
Authors: Doreen Schmidl; Katarzyna Jadwiga Witkowska; Semira Kaya; Carina Baar; Henrik Faatz; Johannes Nepp; Angelika Unterhuber; René Marcel Werkmeister; Gerhard Garhofer; Leopold Schmetterer Journal: Invest Ophthalmol Vis Sci Date: 2015-02-03 Impact factor: 4.799